Small hook thread (Quill) and soft felt internal splint to increase the primary repair strength of lacerated rabbit Achilles tendons: Biomechanical analysis and considerations for hand surgery
Johanna BuschmannAngela MüllerKirill FeldmanTheo A. TervoortGion FesselJess G. SnedekerPietro GiovanoliMaurizio Calcagni
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Biomechanics
BACKGROUND:Haglund's deformity is an abnormal bony enlargement on the back of the heel. It can cause the impact of the posterior calcaneal bursa and Achilles tendon insertion, and finally result in pain. This syndrome is called Haglund syndrome. The purpose of this study was to explore the effect of the suture anchor and allogeneic tendon suture in the treatment of Haglund syndrome. MATERIAL AND METHODS:We retrospectively studied 20 patients with Haglund syndrome treated from January 2015 to December 2016. The patients were randomly divided into Group 1 (the suture anchor group) and Group 2 (the allogeneic tendon group), with 10 patients in each group and an average follow-up of 32 months after surgery. The AOFAS, VAS, and Arner-Lindholm scales were used to summarize the patient follow-up results and complications. RESULTS:In the 2 groups of patients, the postoperative AOFAS, VAS scores, and the Arner-Lindholm scale showed good results. However, the postoperative AOFAS score and VAS of the suture anchor group were better than those of the allogeneic tendon group, with shorter operation times. No Achilles tendon rupture or wound infection occurred during the entire postoperative period in either group. These results show the superiority of suture anchors. CONCLUSIONS:The higher AOFAS and VAS score and shorter operation time in the suture anchor group suggest it is the better alternative for treatment of Haglund syndrome.
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Achilles tendon rupture
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We sought to describe the comparative anatomy of the Achilles tendon in rabbits and humans by using macroscopic observation, magnetic resonance imaging, and ultrasonography. The calcaneus-Achilles tendon-gastrocnemius-soleus complexes from 18 New Zealand white rabbits underwent ultrasound (US) and magnetic resonance (MR) imaging and gross anatomic sectioning; these results were compared with those from a cadaveric gastrocnemius-soleus-Achilles tendon-calcaneus specimen from a 68-y-old human male. The medial and lateral gastrocnemius muscle tendons merged 5.2 +/- 0.6 mm proximal to the calcaneal insertion macroscopically, at 93% of their course, different from the gastrocnemius human tendons, which merged at 23% of their overall course. The rabbit flexor digitorum superficialis tendon, corresponding to the flexor digitorum longus tendon in human and comparable in size with the gastrocnemius tendons, was located medial and anterior to the medial gastrocnemius tendon proximally and rotated dorsally and laterally to run posterior to the Achilles tendon-calcaneus insertion. In humans, the flexor digitorum longus tendon tracks posteriorly to the medial malleolus. The soleus muscle and tendon are negligible in the rabbit; these particular comparative anatomic features in the rabbit were confirmed on the MR images. Therefore the rabbit Achilles tendon shows distinctive gross anatomical and MR imaging features that must be considered when using the rabbit as a research model, especially for mechanical testing, or when generalizing results from rabbits to humans.
Cadaveric spasm
Gastrocnemius muscle
Flexor Digitorum Longus
Calf muscle
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32 ruptures of the achilles tendon were treated surgically in the surgical department of the St. Katharinen-Hospital during the period 1. 1. 1975 to 1. 3. 1980. These cases comprised 28 subcutaneous complete ruptures and 4 open tendon injuries. 29 fresh and 3 old ruptures were operated. The article describes the surgical technique. The median, arcuate incision, the end-to-end suture according to Bunnell with Dexon and, if possible, an interlacing suture with the plantaris tendon, appear to be the essential measures. This is followed by immobilization in a plaster case for a period of 6 weeks. The patients remained hospitalized for a period of 2 weeks after the operation; they were unable to work for 10 weeks, and unable to actively participate in sports for 19 weeks. Half a year to 5 years after the operation, 25 patients were subjected to follow-up examinations. No early or late infection had occurred, and there was also no rerupture or thrombosis. There was also no adherence to tendon and skin. Using the assessment scheme according to B.G. Weber, the functional result must be classified as "good" with all patients.
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Background: Operative intervention is the preferred option for management of the neglected laceration of the Achilles tendon. However, the commonly used techniques rarely follow the principles of the regenerative medicine for the restoration of the lost tissue. This study postulated that incorporation of the autogenous tendon graft would properly progress when the interplay between mechanical loading and healing phases was correctly applied. Methods: A prospective study included 15 patients who were treated for neglected Achilles tendon laceration using the technique of lengthening of the proximal tendon stump. An absorbable reinforcement suture was used for control of the mechanical environment at the suture lines. Results: By an average 5 years of the prospective follow-up, all the repaired tendons had restored continuity and length. The calf circumference equalized to the uninjured side in 12 patients. However, 3 patients had calf atrophy but they improved compared to the preoperative measurements. Sonogram confirmed the restoration of the normal thickness and the gliding characteristics of the repaired tendon. Conclusion: The technique restored continuity and tension of the repaired tendon, preserved the calf circumference, and prevented peritendinous adhesions. The absorbable reinforcement suture spontaneously allowed for the mechanical loading of the grafted tendon. Level of Evidence: Level IV, case series.
Achilles tendon rupture
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Located in the posterior aspect of the lower leg, the Achilles tendon is the thickest tendon in the human body with the ability to resist large tensile forces. It attaches the muscles of the posterior calf, namely the confluence of the distal attachment of the gastrocnemius and soleus muscles to the calcaneus. Originally named after Achilles, a character in Greek mythology, this tendon is also termed the calcaneal tendon, referring to its attachment. However, its more common name is the Achilles tendon.
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The purpose of this study was to investigate the rat's Achilles' tendon morphology and biomechanics changes after treadmill running in order to discuss the mechanism of rat's A- chilies' tendon adaptation to treadmill exercise.Male rats of three-month-old were arranged to have long-term running and a single of running.The structure of fiber,fibril and the activity of tenocytes were observed with optics microscope and electronic microscope and the biomechanics of Achilles' tendon was measured by material testing machine(Instron3365).The result showed that biomechanics didn't change markedly while the disarrangement of fiber and the augment of longitudinal spaces fibril were observed after a single running on the treadmill.Af- ter long-time running the arrangement of fiber and the fibril became more regular.More teno- cytes metabolism was high.The stiffness,the ultimate load and the energy absorbed under the ultimate load increased significantly(P0.05 or P0.01)while the strain of ultimate load and the hysteresis remained unchanged.It concludes that the microstructure of Achilles' ten- don has transient change to unaccustomed load.The Achilles tendon has functional adaptation related to histology and biomechanics after long-term treadmill exercise.
Biomechanics
Treadmill
Strain (injury)
Collagen fibril
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Lumbar hernias are very uncommon conditions. Less than 300 cases have been reported in the literature. They result from defects in the posterolateral abdominal wall. The authors report their experience with four lumbar hernias managed at the "Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo" from 1973 to 1993. Age ranged from 54 to 63 years. Three were female, two had right hernias and two had left ones. All patients were treated surgically. Three were repaired by simple suture. The main complications were early recurrence (one case) and infections (one case). In one, a prosthetic mesh (polypropylene) was used to repair the defect, and the recovery was uneventful. Surgical treatment is always indicated in Grynfelt hernia. Approximation of the muscles by primary nonabsorbable suture, grafts or prosthesis are very adequate therapeutic options for lumbar hernias.
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Limited incision and under parateon suture to repair the acute and closed rupture of achillis tendon
Objective To study the primary clinical result of limited incision and under parateon suture to repair the acute and closed rupture of achillis tendon.Methods A total of 25 achillis tendon ruptured patients were treated with limited incision and under parateon suture method.Amer-Lindholm system was used to evaluate the function.Results The average time of follow-up was 31 months.There were no infection of the incisions and the rerupture of the achillis tendon.There were 22(88%) cases graded excellent and 3 cases good.Conclusion The method of limited incision and under parateon suture to repair the acute and closed rupture of achillis tendon has the advantage of local blood supply protection,minimally invasive,low opptunity of rerupture and infection and good rehabilitation.It was another choice for treating the acute and closed achillis tendon rupture.
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To investigate the clinical result and influence factors of prognosis after repair of ruptured Achilles tendon with operative treatment.From 1961 to 1994, 62 cases with ruptured Achilles tendon were treated operatively. Among them, "8"-shaped suture was used in 8 cases, aponeurosis flap repair in 30 cases, transfer repair of tendon of peroneus longus muscle in 2 cases, reverse "V-Y" shaped tendon plastic operation in 10 cases, and mattress suture of opposite ends in 12 cases.Followed up 3 to 33 years, there was excellent in 40 cases, better in 13 cases, moderate in 6 cases, poor in 3 cases, 85.5% in excellent rate. Postoperative infection and re-rupture were occurred in 6 cases respectively.Different operative procedures are adopted to achieve better long-term clinical result according to the injury types.
Aponeurosis
Peroneus longus
Achilles tendon rupture
Tendon transfer
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